oncology

Gene mutations caused activation of ___ or loss of ____ gene function

• oncogene

• tumor suppressors

True or false

In the plateau growth phase, you have longer tumor doubling times

• True

• it outgrew its blood supply

When can you intervene when looking at the graph

• 10 to the 9th-10 to the 12th

True or false

chemo and radiation are most effective during the plateau growth phase

• False

• most effective during the growth phase. that is why debulking surgery is important

What is required for tumor growth and metastasis. Hint this stage is induced by tumor hypoxia

• Angiogenesis

50% of what 2 breeds will develop cancer at some point of their lives

• Boxers and golden retrievers

What is the only cancer that is inheritable from parents?

• Renal cyst adenocarcinoma and nodular dermatofibrosis of German Shepherd dogs

Three viruses considered carcinogens

• Papillomavirus

• FeLV

• FIV

What cancers do you see in animals who have exposure to environmental tobacco smoke?

• Lymphoma

• oral SCC in cats

2, 4-D, causes what cancers (pesticide herbicide insecticide)

• Lymphoma

• transitional cell carcinoma

Cat has intraocular trauma such as lens rupture. They are likely to develop

• Intraocular sarcoma

True or false

Metallic implants is considered a carcinogen

• True

UV exposure causes what cancers

• SCC

• cutaneous Hemangiosarcoma

• sparse hair covering and light pigmented animals

If you are treating an animal with radiation what risk are they having?

• can develop late radiation tumor

• mostly sarcomas

List four types of cancer cell types

• Epithelial

• round cell

• mesenchymal

• endocrine

Cells in clusters and clumps round nuclei with moderate cytoplasm

• Epithelial tumors (usually end with the carcinoma)

Do epithelial tumors exfoliate well

• Yes

Usually singular elongated cells with cytoplasmic tails

• Mesenchymal

What type of tumors arise from connective tissue?

• Mesenchymal (spindle cell)

• usually end with sarcoma

Do mesenchymal tumors exfoliate well

• No

List five types of round cell tumors (LIMPH-T)

• plasma cell

• lymphoma

• mast cell

• histiocytoma

• transmissible venereal tumor

• ± melanoma

• discrete small to medium sized cells

Do round cell tumors exfoliate well?

• Yes

Free naked nuclei in a sea of cytoplasm

• Endocrine tumors

When presented with the mass, what are the three things you do in order?

• Diagnosis (what is it?)

• staging (extent of disease)

• treatment (options are expectations)

only way to obtain a grade

• Histopathology via biopsy

What type of tumor is highly responsive to radiation therapy?

• Lymphoma

• Also good for brain and nose since not accessible for surgery

True or false

remission means no evidence of cancer anywhere in the body

• True

Three things chemo can provide you

• induce and maintain remission

• delay metastasis

• control local disease

True or false

chemotherapy is a primary treatment for the majority of tumors

• False surgery is the primary treatment

Chemotherapy side effects (BAG)

• Bone marrow

• alopecia (hair follicles)

• GI (intestinal epithelium)

• targets rapidly dividing cells

Why do you have to wait between intervals when administering chemo?

• Have to give time for normal cells to recover

Formula to dose chemotherapy

• MG/M2 (body surface area)

What is metronomic chemotherapy?

• Continued low-dose treatment with a antineoplastic drug combined with an NSAID

• Targets = angiogenesis (due to the low dose this is the target instead of cytotoxic feature, slows everything down)

What is a common indication for metronomic chemotherapy?

• Incomplete resection of soft tissue sarcoma

• Hemangiosarcoma

Standardized way to look at to see and measure tumors to see if they are responding to chemotherapy

• Recist criteria

When you give chemotherapy when do the WBC hit their lowest point

• 5-7 days

• Note: anemia is rare and non-life threatening due to lifespan of 120 days

You do a CBC what are your cut offs to delay treatment?

• Less than 2000 neutrophils or

• less than 50,000 platelets

What constitutes as an emergency in chemotherapy?

• Neutropenia plus fever

• risk of sepsis greatest impatience with less than 1000 cells

Where does the source of infection come from for them to be sepsis?

• from the GI tract

• No more neutrophils in the GI tract leading to translocation

You do a CBC and have less than 1000 neutrophils client has no fever or illness. what do you do?

• Oral antibiotics (broad spectrum) and dose reduction

• if animal has fever or illness, present you hospitalize

If animal has 1000-2000 neutrophils with no fever or illness what do you do?

• No treatment needed

True or false

Alopecia side effect in animals is rare

• True

• more commonly see loss of whiskers and eyelashes

• also, and maybe Toy breed dogs

When would you come see GI signs after chemotherapy

• 3 to 5 days

What agent causes sterile hemorrhagic cystitis

• Cyclophosphamide

What causes hepatotoxicity and significant myelo suppression

• Lomustine

Cisplatin toxicity

• Nephrotoxicity and ototoxicity

• pulmonary edema in cats that is fatal

• cisplatin makes cats go splat

Which causes neural toxicity

• Vincristine

• 5FU

Doxorubicin toxicities

• cumulative Cardiotoxicity

• Nephrotoxicity in cats

• severe vesicant

• anaphylaxis

Which drug is an enzyme that is only effective against lymphoma/leukemia

• L asparginase

How common is canine lymphoma?

• Second to only skin cancer

True or false

intact females have decreased for lymphoma

• True

True of false

Most animals present with enlarged lymph nodes, but are clinically well

• True

• others can have nonspecific signs and PU/PD

84% in dogs have what form of lymphoma

• Multicentric (generalized)

two differentials for solitary or regional lymphadenopathy

• local infection or inflammation

• metastatic disease

What diagnostic test is often diagnostic for lymphoma?

• Cytology

• avoid mandibular lymph nodes if multiple nodes are enlarged

After cytology what is the 2nd best diagnostic test for lymphoma

• Flow cytometry

• Differentiates between T cell, B cell and if large or small

Flow cytometry comes back as homogenous population or if it comes back with heterogenous population of lymphocytes. What would these mean?

• Homogenous = neoplasia

• Heterogenous = reactive disease

What does PARR test detect

• Clonal population of lymphocytes

• low sensitivity, high specificity

• main difference between this and flow cytometry is that this test does not require live cells

Most common type of lymphoma classification you will see

• Diffuse large cell B cell lymphoma

• second = diffuse acute large T cell lymphoma

True or false

Flow cytometry can detect CD 34+ on lymphocytes

• True

What diffuse change would you see with lymphoma during ultrasound of organ architecture

• Swiss cheese appearance

True or false

Barely do bone marrow staging for lymphoma

• True

Stage two lymphoma

• Multiple notes on one side of the diaphragm

• Aka. regional lymphadenopathy

Stage three lymphoma

• Multiple notes on both sides of the diaphragm

• aka. generalized lymphadenopathy

stage four lymphoma

• liver and spleen involvement (lymph nodes do not need to be involved)

stage five lymphoma

• involvement of any non-lymphoid tissue W

Which dogs do worse, B cell or T cell

• T cell

Treatment of choice for lymphoma

• chemotherapy

Multi agent protocol

• C = cyclophosphamide

• H = hydroxydaunorubicin

• O = Oncovin (vincristine)

• P = prednisone

• Gold standard treatment 90% remission rate

How many cycles for CHOP

• repeat five week cycle four times for a 19 week protocol

Most effective drug for a single agent protocol

• Doxorubicin

• given every 2-3 weeks

• MST shorter due to quicker resistance

Steroids alone response rate

• 50%

• MST = 1-3 months

True or false

Do not give steroids without diagnosis or if owner wishes to pursue with chemotherapy

• True

• it decreases remission rates with other chemo protocols by 50% due to resistance now being made

Good rescue protocol if animal gets out of the remission after CHOP

• Tanovea

Dog goes out of remission after CHOP therapy (ie three months after) what protocol should you use?

• Do CHOP again

Is lymphoma often found in the lung

• No

• thats why two view radiographs are sufficient because only looking at the nodes

True or false

like dogs and cats lymphoma is also mainly multicentric/nodal

• False

• multicentric/nodal form is rare

What type of cats develop spinal mediastinal, peripheral nodes, ocular and renal lymphoma

• usually younger cats with FeLV

Which type of cats develop nasal, alimentary lymphoma

• usually older cats without FeLV

True or false

Environmental tobacco smoke increases cats risk to lymphoma

• True

Older cat with GI lymphoma are they usually FeLV positive or negative

• Negative

Which sex is more predisposed to lymphoma, male or female cats

• Male

• note: breeds DSH and siamese

Why is biopsy often required for feline lymphoma whereas in dogs psychology is good enough for diagnosis

• nodular presentation is rare so you need to go get a biopsy internally from wherever the lymphoma is

True or false

Expect shorter survival times with lymphoma and FeLV/FIV together

• True

Does immuno phenotype of lymphoma matter in cats for prognosis

• No

True or false

A full staging diagnostic is often indicated in cats

• True

• unlike dogs, they can have it in one area or spread all over the body

lymphocytes (small cell) grade

• low-grade

What is high grade

• Lymphoblast (large cell)

Feline GI lymphoma occurs more in small or large intestine

• small intestine

What is more aggressive, small cell or large cell lymphoma?

• Large cell

Protocol for small cell lymphoma

• Chlorambucil and prednisolone

Protocol for large cell

• CHOP

Good prognosis with 90% treatment response with clinical signs resolving in 1-3 months of treatment initiation

MST = greater than two years

small cell or large cell lymphoma?

• This small cell lymphoma prognosis

What is the response rate and MST for large cell lymphoma?

• Response rate = 30-50%

• MST = 3-5 months

What imaging device can you use to diagnose nasal lymphoma?

• CT scan

• rhinoscopy for biopsy

Treatment for nasal lymphoma that is not systemic

• Radiation therapy

• MST = 1.5-3 years good prognosis

• if systemic add chemotherapy CHOP protocol

three year old cats comes in with muffled heart and lung sounds. FeLV test was positive.

what should be on the top of your differential?

• Mediastinal lymphoma

How can you diagnose mediastinal lymph node

• fine needle aspiration of the pleural fluid

what results of the cytology would indicate a mediastinal lymphoma?

• intermediate to large lymphocytes (CHOP protocol)

• small lymphocytes indicate chylous like effusion

When is the only time you will do a single excisional biopsy that is also therapeutic

• single node enlargement in felines (Hodgkin’s like lymphoma)